Andrew Ivsins

A 'standard joint'? the role of quantity in predicting cannabis-related problems

The ‘standard drink’ concept is widely used as a standardized measure of alcohol consumption. There is no equivalent measure of cannabis consumption, perhaps due to challenges such as varied joint size, tetrahydrocannabinol content, and means of delivery. This study introduces a new measure of cannabis quantity and examines whether it predicts cannabis-related social problems with and without controlling for frequency of use. Cannabis-related problems, measured by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), were predicted from cannabis use frequency (days in past month) and quantity (one joint = 0.5 g, five bong or pipe hits, 10 puffs), controlling for age and gender. The sample consisted of 665 participants aged 15–67 (mean = 28.2, SD = 11.8) from the British Columbia Alcohol and Other Drug Monitoring Project, High Risk Group Surveys, 2008 to 2009. Cannabis use frequency and quantity were positively associated with cannabis-related problems. Individuals who consumed cannabis daily and consumed more than one joint per day were at the greatest risk of problems. Controlling for frequency, the effect of quantity remained significant for failure to do what is expected due to cannabis use. This study suggests that quantity, above and beyond frequency, is an important predictor of cannabis problems. We discuss the potential usefulness and validity of this new measure in harm reduction.

Toking and driving: Characteristics of Canadian university students who drive after cannabis use—an exploratory pilot study

Cannabis use is increasingly prevalent among young adults in Canada. Due to cannabis’ impairment effects, driving under the influence of cannabis has recently developed into a traffic-safety concern, yet little is known about the specific circumstances and factors characterizing this behavior among young people. In this study, we interviewed a sample of university students (n = 45; age 18–28 years) in Toronto who had driven a car after cannabis use in the past year. The study collected information on respondents’ sociodemographic characteristics, cannabis and other drug use, cannabis use and driving (CUD) experiences, law enforcement and accident exposure, perceptions of cannabis and alcohol impairment effects as well as future anticipated substance use and driving behaviors. Results indicated that: CUD originated primarily from social settings; that impairment risks from cannabis were perceived to be low; and that the level of anticipated future CUD was high. Furthermore, high frequency of CUD in the past year was associated with high frequency of cannabis use. Interventions aiming at CUD among young people need to be anchored in the specific sociocultural settings of this behavior; targeted information needs to address cannabis’ impairment potential for driving; possibilities for harm-reduction measures for CUD need to be considered.

Social, health and drug use characteristics of primary crack users in three mid-sized communities in British Columbia, Canada

Aims: Despite the increased prevalence of crack use, research on street drug use in Canada currently focusses mainly on injection drug use and/or use in large urban centres. This studys objective was to assess the distinct socio-demographic characteristics, drug-use patterns, health profiles and risk behaviours as well as intervention needs of primary crack users in three mid-sized communities in British Columbia, Canada. Methods: Study participants were recruited with the help of local service agencies and peer recruiters, and assessed between July and November 2008 based on a protocol involving quantitative, qualitative and biological measures. Findings: The majority of the samples: reported unstable housing/homelessness; relied on social benefit payments for income generation; were under current criminal justice supervision; were poly-drug users, using other drugs like alcohol, cannabis or opioids; reported physical and mental health problems; were hepatitis C virus positive; had numerous crack-use episodes per day; frequently shared crack-use paraphernalia; and obtained crack pipe paraphernalia from makeshift items. Conclusions: This study documents crack use as a prevalent street drug use activity associated with extensive social and health risks and harms, which currently are not sufficiently addressed by the existing interventions in the study sites. Concerted attention to, and delivery of, targeted prevention and treatment interventions for the public health problem of crack use in Canada is urgently required.

Sexual identity and drug use harm among high-risk, active substance users

Research shows that sexual minorities are at greater risk for illicit substance use and related harm than their heterosexual counterparts. This study examines a group of active drug users to assess whether sexual identity predicts increased risk of substance use and harm from ecstasy, ketamine, alcohol, marijuana, cocaine and crack. Structured interviews were conducted with participants aged 15 years and older in Vancouver and Victoria, BC, Canada, during 2008–2012. Harm was measured with the World Health Organizations AUDIT and ASSIST tools. Regression analysis controlling for age, gender, education, housing and employment revealed lesbian, gay or bisexual individuals were significantly more likely to have used ecstasy, ketamine and alcohol in the past 30 days compared to heterosexual participants. Inadequate housing increased the likelihood of crack use among both lesbian, gay and bisexuals and heterosexuals, but with considerably higher odds for the lesbian, gay and bisexual group. Lesbian, gay and bisexual participants reported less alcohol harm but greater ecstasy and ketamine harm, the latter two categorised by the ASSIST as amphetamine and hallucinogen harms. Results suggest encouraging harm reduction among sexual minority, high-risk drug users, emphasising ecstasy and ketamine. The impact of stable housing on drug use should also be considered.

The Canadian Recreational Drug Use Survey: Aims, Methods and First Results

In late 2006, pilot research was initiated in two western Canadian sites (Vancouver and Victoria) to systematically monitor patterns and trends in three specific illicit drug user populations: club and rave party attendees, adolescent street involved injection and non-injection drug users, and adult injection drug users. These sentinel groups were selected because of elevated rates of alcohol and other drug use within these populations and contexts, and the high levels of associated risks and harms. Drawing from international monitoring and surveillance systems, novel research instruments were developed for each population and were administered in face-to-face interviews at each study site. This paper presents an overview of the broad research methodology for the “high risk” monitoring research as well as select findings for the “club drug” sample. The piloted research design yielded high quality data, particularly in relation to recent patterns of drug use behaviour (items on drug use “yesterday” and “last weekend”). The success of these novel items highlights the value of the present study and its relevance for similar studies across the country.

An examination of injection drug use trends in Victoria and Vancouver, BC after the closure of Victoria's only fixed-site needle and syringe programme.

BACKGROUND Needle and syringe programmes (NSPs) have been established as effective harm reduction initiatives to reduce injection drug use (IDU)-related risk behaviours, including sharing needles. On May 31, 2008, Victoria, BCs only fixed site NSP was shut down due to community and political pressure. This study examines and compares IDU trends in Victoria with those in Vancouver, BC, a city which has not experienced any similar disruption of IDU-related public health measures. METHODS Quantitative and qualitative data were collected by interviewer-administered questionnaires conducted with injection drug users (n=579) in Victoria and Vancouver between late 2007 and late 2010. RESULTS Needle sharing increased in Victoria from under 10% in early 2008 to 20% in late 2010, whilst rates remained relatively low in Vancouver. Participants in Victoria were significantly more likely to share needles than participants in Vancouver. Qualitative data collected in Victoria highlight the difficulty participants have experienced obtaining clean needles since the NSP closed. Recent injection of crack cocaine was independently associated with needle sharing. CONCLUSIONS The closure of Victorias fixed site NSP has likely resulted in increased engagement in high-risk behaviours, specifically needle sharing. Our findings highlight the contribution of NSPs as an essential public health measure.

The British Columbia Alcohol and Other Drug Monitoring System: Overview and Early Progress

This pilot project is a province-wide and nationally=supported collaboration intended to add value to existing monitoring and surveillance exercises that currently exist and are being developed in Canada. The fundamental aim is to create a system that generates a timely flow of data on hazardous patterns of substance use and related harms so as to inform public debate, to support effective policy, and to facilitate policy-relevant epidemiological research. Pilot and feasibility exercises have been conducted in relation to developing consistent questions in surveys of general and special populations, treatment system data, data on the contents of drugs seized by police, interviews with police, rates of alcohol and other drug mortality and morbidity, alcohol sales data, and data from the emergency departments. Wherever possible, links with the equivalent national data collection processes have been established to create consistencies. This article provides a general overview of the BC pilot monitoring system and discusses some potential advantages of planning and designing a comprehensive system with built-in consistencies across data collection elements.

Nonfatal overdose from alcohol and/or drugs among a sample of recreational drug users

Abstract The purpose of this study was to examine nonfatal overdose events experienced among a sample of recreational drug users. We sought to determine predictors of nonfatal overdose from alcohol and/or drugs among a sample of recreational drug users. In addition, we examined the substance(s) used at the last overdose event. Methods: Participants were 637 recreational illicit drug users (had used illicit drugs other than marijuana, in a club or party setting), aged 19 or older, from Victoria or Vancouver, British Columbia, Canada. Data were obtained in structured interviews conducted from 2008 to 2012 as part of the Canadian Recreation Drug Use Survey (CRDUS). Results: In the 12 months prior to interview, 19.3% (n = 123) of the participants had experienced an overdose. In multivariate analysis, younger age, unstable housing, and usually consuming eight or more drinks containing alcohol, when drinking, significantly increased overdose risk. In addition, polysubstance use was reported by 67.5% (n = 83) participants at their last overdose event. Conclusions: Intervention and prevention measures seeking to reduce overdoses among recreational drug users should not only address illicit drug use but also alcohol and polysubstance use. In addition, measures may target those who usually consume high amounts of alcohol when drinking are younger and who experience housing instability.

Community Managed Alcohol Programs in Canada: Overview of Key Dimensions and Implementation

INTRODUCTION AND AIMS People with severe alcohol dependence and unstable housing are vulnerable to multiple harms related to drinking and homelessness. Managed Alcohol Programs (MAP) aim to reduce harms of severe alcohol use without expecting cessation of use. There is promising evidence that MAPs reduce acute and social harms associated with alcohol dependence. The aim of this paper is to describe MAPs in Canada including key dimensions and implementation issues. DESIGN AND METHODS Thirteen Canadian MAPs were identified through the Canadian Managed Alcohol Program Study. Nine key informant interviews were conducted and analysed alongside program documents and reports to create individual case reports. Inductive content analysis and cross case comparisons were employed to identify six key dimensions of MAPs. RESULTS Community based MAPs have a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health and social services. MAPs are offered as both residential and day programs with differences in six key dimensions including program goals and eligibility, food and accomodation, alcohol dispensing and administration, funding and money management, primary care services and clinical monitoring, and social and cultural connections. DISCUSSION AND CONCLUSIONS MAPs consist of four pillars with the alcohol intervention provided alongside housing interventions, primary care services, social and cultural interventions. Availability of permanent housing and re-establishing social and cultural connections are central to recovery and healing goals of MAPs. Additional research regarding Indigenous and gendered approaches to program development as well as outcomes related to chronic harms and differences in alcohol management are needed.

Exploring what shapes injection and non-injection among a sample of marginalized people who use drugs

BACKGROUND Few studies have specifically explored what influences people who use drugs to consume them in certain ways (i.e., smoking, injecting). While a great deal of research has examined the transition from non-injection to injection routes of drug administration, less is known about people who use drugs (PWUD) but have never injected or have stopped injecting. This paper draws on actor-network theory to explore what moves people to inject or not, among both people who currently smoke/sniff drugs (PWSD) and people who currently inject drugs (PWID), to better understand factors that shape/influence methods of drug consumption. METHODS Two-stage interviews (a quantitative survey followed by a qualitative interview) were conducted with 26 PWSD and 24 PWID. Interviews covered a range of topics related to drug use, including reasons for injecting drugs, never injecting, and stopping injecting. Data were analysed by drawing on actor-network theory to identify forces involved in shaping drug consumption practices. RESULTS We present three transformative drug use events to illustrate how specific methods of drug consumption are shaped by an assemblage of objects, actors, affects, spaces and processes. Rather than emphasising the role of broad socio-structural factors (i.e., poverty, drug policy) participant narratives reveal how a variety of actors, both human and non-human, assembled in unique ways produce drug consumption events that have the capacity to influence or transform drug consumption practices. CONCLUSION Actor-network theory and event analysis provide a more nuanced understanding of drug consumption practices by drawing together complex material, spatial, social and temporal aspects of drug use, which helps identify the variety of forces involved in contexts that are thought to shape substance use. By attending to events of drug consumption we can better understand how contexts shape drug use and related harms. With greater insight into the transformative capacity of drug use events, strategies may be better tailored to prevent drug use-related harms.